The recent summertime resurgence in respiratory syncytial virus (RSV) activities in Texas, resulted in HHSC’s decision to gradually open all DSHS regions allowing all members who meet prior authorization criteria to received monthly doses of Synagis (palivizumab). To address concerns for the appropriateness of giving additional doses or starting new therapy during the fall and winter season, providers will be required to re-assess the need for prophylaxis therapy for the members in their regions as of October 1, 2021. Providers must request a new prior authorization and if approved, members will be eligible for up to 5 monthly doses of Synagis (palivizumab). The fall and winter season schedule for each region will be available for reference. The Vendor Drug Program website also has instructions for obtaining prior authorization for clients enrolled in fee-for-service Medicaid.
The instructions for obtaining prior authorization for people enrolled in Medicaid and CHIP managed care, traditional Medicaid, and the CSHCN Services Program are now available.